Rooker | The Positive Paramedic Project | #110 You’re not dead?!


This is a repub of a 2008 Norm Rooker column.

“You’re not dead?!”

Just what is the correct response when this is the initial greeting from someone who knew you from back when? The occasion was the 2008 Fire-Rescue Med Conference in Las Vegas. I was attending the national roll out for the Ambulance Strike Team Leader class. (A good program and one well worth taking by EMS supervisory and middle management types.)

It was the opening part of the class where each of us stood up and introduced ourselves, who we worked for and how long we had been involved in EMS. Because this was a roll out, there were a number of us older dog medics taking the program to evaluate it for our services or areas, so my almost 35 years of EMS experience only earned me a fifth place seniority ranking in the class.

One of those ahead of me turned out to be a coworker for a service I worked for back in the late 70’s after graduating from paramedic school and prior to being hired by the City of St. Louis EMS. After he introduced himself and I was thinking that he looked familiar he turned to me and uttered those words.

We all had a good laugh and when you’re greeted with a public comment like that from a senior medic your class reputation is well on the way to being established. The ASTL course progressed and while we ran a little long with anecdotes about EMS responses to Hurricane Katrina, various earthquakes in California from the 1989 Loma Prieta Earthquake to the North Ridge Earthquake and more recently, the EMS response to last October’s wildland fires in southern California and even the recent papal visit to Washington, DC, the material was all relevant for the tasks that needed to be accomplished.

Afterwards I pondered my former coworker’s statement. This was not the first time I had heard this sentiment. Fourteen years earlier at my 20 year high school reunion I ran into Mr. Petty, one of my senior year English teachers. He was walking towards me and when we got close but before I could say hello he stopped dead in his tracks.

He looked at my name badge. After all I had filled out some since graduation and was well on the way to balding, make that bald. Some of that by nature and maternal genetics and the rest enhanced by an ambulance accident where I flew head first into the front cabinets and avulsed the top of my head down to the skull.

While I had serious railroad tracks and a growing yamaka spot, I still had hair on top of my head until that moment. They had to do a skin graft to cover the wound and I was darn lucky that I hadn’t broken my neck. I still have an arthritic thoracic vertebra from that accident. But that was five years prior to the reunion and I was healed up now.

Anyway Mr. Petty looked at me, looked at my name tag again, sighed and stated something along the lines that I was one of the ones that he was sure would be listed as among the honored dead by this reunion and that he had actually been surprised to see me at the 10-year reunion.

I just snorted and said ‘Nope, I was still here and planned to be for awhile’ but at the same time I was a bit taken aback by his comments. After all, it wasn’t like I was a hood, stoner or troublemaker in school. It was more that I was not what you would call a low maintenance student or employee.

Well that and the fact that I was not afraid of confrontation.

I attribute this to the times and to my parents. And for that matter my grandparents. My maternal grandmother was an active young lady who lived in the fast lane of her times. Think of the musical CABARET. Grandma Stamat was a flapper and was living the Berlin cabaret and nightlife scene when Hitler’s Brown shirts did Krystal Nacht. Being an American citizen she was able to get out but almost my entire maternal family line for her side of the family was lost to the Holocaust.

Her second husband, my mother’s step-dad but the man I knew as my grandfather was a loud character. A merchant seaman stuck in Hong Kong during the Boxer Rebellion, a US Calvary man who was part of the American Expeditionary Forces that chased Pancho Via into Mexico and a few years later was in one of the first units to go to France in World War One. He left the Army after the war and worked a number of jobs including being a union “enforcer” in the Chicago area during the labor troubles and organizing in the post war and depression.

My father was an Iowa share cropper’s son, the third of six kids, born on my grandmother’s 20th birthday. He was an all-state athlete who battled with an abusive father, dropped out of high school at the end of the football season his senior year. And in the American tradition, after meeting and falling in love with my mother, and powering through my grandfather’s initial disapproval, pulled himself up by the bootstraps, worked his way through college and became a very successful Chemical Engineer.

I was the oldest of three kids. My brother JD and my sister Meredith were three years younger. My sister was very severely mentally retarded and had both Down’s Syndrome and Hurler’s Syndrome. So from a young age I always had to come straight home form school to help take care of my brother and sister so mom could do chores like grocery shopping and getting dinner ready, etc.

As we kids grew, my parents were moving into the middle to upper middle class. We were living in a suburb of New York City and had the benefits of their hard work. But my parents wanted us to appreciate how well we had it compared to what they had when they were growing up. So my mom came up with the Christmas letter program.

Each year she would go down to the main post office in New York City and read through the letters to Santa Claus. She and my dad would select a destitute family, contact the parent or parents and make sure it was OK, and then get my brother and I involved in providing Christmas presents and dinner for them.

Everything from going through our own toys and picking out something that was in good condition that the letter identified these kids would like, to purchasing, and gift wrapping other presents. Then as a family we would drive into some of the worst parts of New York City and make the delivery.

It was an eye opener and a tradition that Vicki and I continued for several years with our own children.

It was also a time of the early civil rights and women’s liberation movements. When I was 11 my mother and father signed up for the Fresh Air Program. This was a program where we would host two inner city kids, Larry and Marshal, for what turned out to be the next four summers.

All this BS about race and other differences mostly disappear when kids just get to be kids. I learned that not all black people are natural athletes. That they were able to get sunburned, too.

Each summer we would go down to Fenwick Island near Ocean City, Maryland. It wasn’t until much later that I realized that these weren’t really vacations for my parents, however we kids always had a great time.

Swimming, fishing, crabbing and learning how to play draw and stud poker for sea shells. (I ended up with a pretty neat shell collection which I held onto until my junior year in high school when I passed it on to a lovely young lady.)

This was during the mid to late 60’s and race relations weren’t exactly all they could be in that locale back then. One or the other of my parents had to get up early every morning and accompany us four boys to the beach or to the bay to ensure our safety.

We didn’t appreciate this sacrifice back then. We were just four boys between the ages of 8 and 12 having fun. All four of us would be at the beach playing in the ocean and sand all day. The third day we were there was a particularly bright and brilliant day and boy did we pay for it that night and the next day.

Larry and Marshal became such a part of our family that when my parents decided to divorce after my sister died, they waited until the Christmas Holidays so all four of us kids were together before they announced it.

Prior to that sad moment, my mother had also became involved in the Women’s Liberation Movement. I was 14 when she began hosting women’s self help medical exams at our house the third Sunday of every month. While I had no idea what this meant, it was pretty cool because my brother and I got to go to the movies those afternoons.

I didn’t find out what was actually going on until a few months later when my mom sent me up to her room to grab a flashlight out of her bedside drawer and I found a plastic speculum. My 14 year old mind did not have a clue what this was for but I brought it downstairs with the flashlight, holding it upside down and making quacking noises as I asked my mom what it was.

That old cliché about being careful about what you ask for comes back to mind as I was sat down and learned way more than I ever wanted to. At least at that time in my life.

My sophomore year of high school I was on the wrestling team. After a long six weeks of hard practices I had made the decision that it was time for me to bring my jock strap home and wash it. (You know it’s got to be bad when a 15-year-old boy decides this garment is to gross even for him.)

By now my brother and I had been doing our own laundry for a couple years. While I was sorting my clothing my mother was trying to come up with a poster idea for the first parade for the ratification of the Equal Rights Amendment by the New York State Legislature.

This is where being a creative smart butt sort of got me into trouble, again. As I was moving my crusty bit of athletic apparel to the whites pile I said something along the lines about putting a bra and a jock on a poster with something about equality.

My mom yells “Brilliant!” and snatches this stained and crusty item from my hands. My pleas to at least let me wash it first fell on deaf ears and that is why my jock strap along with one of my mother’s black brassieres and the words, “Ratify the ERA, Connecticut NOW” appeared in what turned out to be one of the most photographed posters of the rally with numerous shots of it in the New York Times and the New York Daily Post.

Needless to say, backing down or shying away from a challenge or trouble was not a family trait.

At that time in my life I was somewhat active in sports. Not a great athlete but game, if a bit on the lazy side. I was active in Boy Scouts and a cadet in the Civil Air Patrol. My squadron ran a ground SAR team.

Through these organizations I took basic and advanced first aid training as well as both the American Red Cross junior and senior lifesaving programs.

I was also in Future Teachers of America and I taught swimming Friday afternoons to the developmentally disabled class as well as wrote and worked on the student newspaper. All of these activities taught me to question what I didn’t think was right or pursue the question until I understood it.

The upside was that all of these activities led me to be selected for the second pilot EMT course they ran in the State of Connecticut in 1973 over the summer between my junior and senior years.

One of the downsides was that I sometimes clashed with or challenged authority. Never, ever in a destructive or mean spirited way. Well, I was suspended for fighting once my senior year but that was a provoked situation and testosterone rather than thinking things through got me in trouble on that one. I made the best of it and spent my entire suspension teaching PE over at Western Junior High School.

But overall I was a good kid. I accepted no for an answer, eventually. Never in trouble with the law and a decent, if underachieving student.

The fall of 1974 I reported to Ripon College, in Ripon, Wisconsin. A small enough school that it was possible to be a walk-on and actually make the football team. I had never played organized football before but I was just big enough and apparently just good enough to make the team.

I was a nose tackle. I had never thought of myself as being particularly small but I quickly learned that at 5’10” I was shortest lineman on the team. It turned out I was the shortest defensive lineman in the entire conference.

I learned very quickly, actually with the “help” of my philosophy instructor that physical size was only part of the equation when it came to battle on the line. You see, my Introduction to Philosophy professor also happened to be the offensive line coach.

If I “discussed” an opposing point of view too much in his class that morning, that afternoon he would “borrow” me from the defensive line unit to run what can be best described by Gary Shaw’s 1972 book, MEAT ON THE HOOF: The Hidden World of Texas Football, as Shit Drills.

I would go one on one with each member of the offensive line. Pass rushing as well as just your standard one on one confrontation for dominance of the line. Then there was the two-on-one, trap blocking drill. This is where the center or offensive guard in front of me would pull away and I would be hit by the offensive guard or tackle next to him.

But my absolute “favorite” was the interception drill.

I would be pass rushing against five of them protecting the coach who would toss the football just over their heads. I would have to leap up and catch it and they would have to react to my “interception” by stopping me from gaining any yardage. I crawled home from those practices.

Heck, I was the third shortest member of the team. I was lining up against guys so much taller than me that at eye level, I was looking at their neck and in two cases, the number on their chest when we both stood up straight.

For that matter only two of our cheerleaders were my height or shorter.

As a lineman I was mediocre at best. But I learned how to hold my own and think through ways to use what I had to my advantage. And I never did seem to learn the other lesson my philosophy instructor was attempting to teach me.

As a nose tackle, I was third-string on a two-string team. Ripon being a small college. But on special teams, that was an entirely different story. Man, for an AADD type, it was the best gig on the team. For me, that was where it was at! All that building excitement and noise leading up to the ball being kicked and running down field, the crowd roaring and the wind whistling through the ear holes of my helmet as I lined up on one or two members of the receiving team and just piled into them.

As with many things in my life, it was a matter of luck and opportunity coming together to help me in ultimately being named “Bomber of the Year” by the coaches. But as usual, I am getting ahead of myself.

In 1975, the NCAA, in an effort to cut down on knee injuries made it illegal to throw a cross body block below the waist on kickoffs. Guys that had been playing football since Jr. High and High School had all been taught the cross body block method or to slide feet first into the opponent.

Consequently, in this first season of the new rule, none of them really knew how to hit or block their opponent on kick offs. I learned by accident the first time. I stumbled while trying to turn to adjust to the ball carrier and in a high speed stumbling fall just happened to wipe out the guy in front of me. That’s when it occurred to me.

Most people don’t want to be hit. No matter what their size. They would rather push and shove. Fortunately I played for a pretty good team and was able to put my theory to test in the next quarter. I picked the biggest guy on the receiving team and cleaned his clock.

After that I would just sail down field, pick my target and take them out — opening up a hole in the wall for the other members of my team to take down the ball carrier. I never once directly tackled the receiver, although one time I did hit a blocker with enough force that he took out his own ball carrier.

Between the values my parents and grandparents taught me, the responsibility for taking care of those less fortunate or weaker than me from an early age, to that lessons I learned on the football field, to finally, the lessons Liz taught me (see March 16th’s column Tough Enough) I apparently was what you might call a high profile EMT and later paramedic.

Staying below the radar just wasn’t in my nature.

I never abused patients or derelicts. I never picked fights. For that matter, I never, ever punched anyone. That is an offensive tactic. My father taught me that there will always be someone bigger stronger or faster so fighting is always an option of last resort.

But if you do take that course. You don’t do it to come in second. And you never do it to showoff, or bully.

This has been my philosophy throughout my career on and off of the streets.

That included Special Operations such as rope rescue, structural collapse rescue, firefighting, Tactical Medic, etc.. Along with some of the interactions at certain fire houses after our “merger of equals” where the Paramedic Division was removed form the San Francisco Department of Public Health and inserted into the SF Fire Department in 1997.

But getting back to last week’s Fire-Rescue Med Conference, I ran into another former coworker, Jonathan Chin, who Vicki and I had worked with at Medevac in Santa Clara County, CA back in 1985/86 while we were waiting for the City of San Francisco to pick us up. Medevac had the contract to provide EMS for the southern half of the City of San Jose and Santa Clara County.

Jonathan is a handsome and articulate Chinese-American who quietly radiates leadership and charm. While neither of us were ever partnered up with Jonathan, we often ran into him and his partner, Cindy Petretto at various hospitals. They were a good solid crew. Medically dialed in and they always pulled their share of the load.

One day my partner and I had brought in a middling-serious trauma patient from a motor vehicle accident to Valley Medical Center — The Big Valley, a level one trauma center. At that time the ER was one long room with gurneys down either side, a nursing station in the center, two trauma rooms and in the back, a sort of three-bed quiet area for less acute patients and folks that needed sobering up.

While I was writing up my PCR, Jonathan and Cindy came in with a huge biker type. I mean pro-wrestler size. Multiple abrasions and reeking of alcohol. As they were wheeling him towards the “Quiet Room” he kept muttering abuse towards Jonathan.

“You Gook”, F***ing Gook”, “You slimy Gook”, ‘You..”, well, you get the picture.

Jonathan ignored him and Cindy rolled her eyes at us as they wheeled him past and into the Quiet Room. A minute later Cindy came bursting back out.

“Help! He’s going to kill Jonathan!”

Paperwork went flying as my partner and I and another crew from SCV, the company that had the EMS contract for the northern half of San Jose and Santa Clara County beat feet for the room while a nurse called security.

I was first through the door and there was Jonathan trapped in a corner between the walls and a hospital gurney. His angry patient was towering over him. But Jonathan wasn’t cowering or blustering. He was standing tall in a neutral stance looking up at the belligerent biker.

As I started to take my leap to tackle this guy high I heard Jonathan say, “Lets get one thing straight. It’s not gook, it’s Chink!”

Now that’s being calm under fire. Jonathan has since gone on to obtain his master’s degree in administration of EMS, has been the EMS Director for the State of Oregon and now runs EMS for a large county in northern Oregon.

While we were catching up on each others lives, respective families and careers I mentioned the comment in class about a coworker acting surprised that I was not dead by now.

He smiled and stated that while I was never a bully or troublemaker, per say, even with union activities, that the reason some people might get that impression is that I was always in the middle of things. That no matter what, an assault on a coworker, a working condition or a protocol or procedure controversy, I always stepped in and did what needed to be done or said what needed to be stated. And for those that sat on the sidelines, that level of risk taking was seen as either threatening or something that could lead to unfortunate or negative consequences.

I smiled back as his observations made sense to me. And yes, there have been rewards, triumphs, consequences and scars. So Mr. Petty, Professor Boweles and countless others I have known, worked with or for over the decades — I’m still here and plan to be for years to come.

Be well. Practice big medicine.

Norm Rooker

Newman | The Positive Paramedic Project #109 | Condition White


I wrote this stream-of-consciousness piece as a ‘soundtrack’ for a series of mixedtapes sent to a few well chosen friends.

Have you ever considered Condition White? Condition White is the lowest end of the mental awareness spectrum developed by American law enforcement instructor Jeff Cooper.

Condition White, according to the disciples of Cooper, is a state of near total relaxation—when you are blissfully unaware of your immediate surroundings.

And for that reason, Condition White is a leave-at-home mental status thing for on-duty street medics. So, it was with beaucoup de surprise that I, a devoted student of the School of Street Survival, found myself floating in Condition White.

We were rolling to a call in The Altered States (aka: the suburbs). Requested to fill in for another Med Unit that was temporarily unavailable.

François was severely into Condition Yellow/Orange—providing me with a running commentary of the things we would have to watch out for on the scene—whenever we got there. François continued his pre-assault coverage, but I was visiting previously charted territory in Condition White.

I was watching the leaves swirl in the wind. I was lost in the rain pounding the pavement into little soldiers. I caught myself remembering the pure innocence of running down Main Street—the wind blowing in my breathless face as the siren wailed.

Running to the firehouse to get lost in the smalltown comraderie of a Bethany fire call. West Liberty needed assistance on a barn fire and Bethany Fire & Rescue was answering the call.

Something special about neighbours responding to each others’ needs without reservation—without concern for payment for services rendered—with only compassion and a willingness to lend a hand in their hearts.

And when I returned to my home there was that unique rearboard windglow on my cheeks. Challenged, the spirit had overcome. The exciting smell of smoke lingered on past the requisite steaming shower. We were good. We were volunteers. It seemed so simple. And right. And maybe just a bit innocent, too.

Condition White is life-threatening in a world gone grey. The innocence lost while screaming to a shooting call in RDP. U2’s Desire pounding out a backbeat to the wailing siren.

The lights of oncoming traffic reflected splitsecond in the windshield. Seven minute high speed slalom through disinterested streets.

The brotherhood of fear linking my partner and I work a trauma code on a blood soaked victim of terminal criminal involvement.

Watching our backs and watching our fronts as too young police officers roam the avenue with flak jackets on and automatic weapons keyed up. Controlled madness leads to shivering teeth inside these tight-clenched jaws. Reflecting calm even in this arena of insanity.

When I get home I am spent. Even the dog’s angled glance of not knowing is too much for me. I turn off the light and drop into dreamless sleep. Work is an exercise in creative confusion.

10881691_10152916542040902_1186545828089801244_nStill I find myself drawn to the station an hour before my shift. Waiting to ride the rig back into my neon war zone.

It is as if I enjoy these excursions into grey.

Be well. Practice big medicine.


Newman | The Positive Paramedic Project #6 Look, listen & feel

A nugget of EMS organizational wisdom every day. #6 Look, listen & feel.

Look, listen & feel. Those three words were ingrained into my consciousness a long time ago – long before I was ever charged with leading a team of emergency medical services [EMS] providers. And yet, sometimes the most obvious eludes us as we focus on the process and neglect our people. 

Back in the day, Ed Pietroniro was one of our Clinical Team Leaders (CTL) at CSL EMS. He was a superb clinician with strong leadership qualities and the ability to read a problem from many different angles before even attempting resolution. Ed’s a big guy—square shoulders on a solid frame—a human eclipse of a medic. He liked to wear his hair in an early-American-USMC buzz cut. He was intimidating to look at until you saw him caring for a client. Gentle, polite, and decidely delicate for someone who probably didn’t need Fire Department assistance on a Forcible Entry call. Ed was a firefighter/ security officer with Pratt & Whitney Canada. We liked to call him Special Ed.

Special Ed liked to wander into my office—the door was always open. He didn’t knock or say anything to announce his presence. I’d be working on the computer and turn around to see Ed settling into the guest chair in my office. It was a tight fit so he tended to assume a lounging position in the chair. Legs sprawled out in front of him the heels of his boots digging dents in the tragically worn carpet. Ed liked to grab whatever was handy on the end of my desk and twirled it in his hands. It’s usually a distracted conversation for someone so focused. He’d say, “Hal, are you busy?” I’d say, “What’s up, Ed?” and Special Ed would tell me a story.

After going missing-in-action for almost a month on CSL EMS, Ed fell into the guest chair. He had only been named to the Clinical Team Leader position a few days before he had virtually disappeared and I had asked him to resign the post. As Head Coach, I didn’t want to see our crack at a new paradigm shattered before we really got underway. We needed CTLs who formed the heart and soul of their respective teams. I believed Ed hadn’t taken the role seriously—any and all attempts to coax him into The EMS House had been made in vain.

I should have known something was wrong by the way Ed was sitting in the guest chair. Ramrod straight with his eyes focused on a spot on the Old Glory curtain hanging behind my head. Boots held tightly together—knees bent at ninety degrees. “Hal, are you busy?” “What’s up, Ed?” Ed told me a gripping story. His team responded to a call for “a man down” on the sprawling Pratt & Whitney Canada campus. When they arrived they found a fifty-something-year-old male in cardiorespiratory arrest. Using the AED that he had fought so hard for the company to purchase, Ed resuscitated the gentleman. He was elated. Ed has always displayed enormous pride in his thirteen years of emergency services work at Pratt & Whitney. He was always regaling us with stories about new ambulances, and the “Foam Boss” crash/rescue truck they had at their Saint-Hubert Airport Test Facility.

I congratulated Ed on saving a life. It did not seem to register. Special Ed was just staring at me—or more accurately, through me. “What’s wrong, Ed?”

And then the impossible occurred. Special Ed crumpled forward, his eyes filled with tears. The chiseled face dissolved as Ed cried into his big hands. “Pratt & Whitney Canada outsourced the emergency services department. All forty of us have been fired. They’re replacing us with private security guards.” “When did you find out?” “They told us three and a half weeks ago.” The time Ed was missing-in-action. “Why didn’t you let me know.” “I just couldn’t tell anyone. I was devastated. Thirteen years and no warning and that’s it—it’s all over.” A scant six weeks before Christmas 1999 and Special Ed Pietroniro had lost the job he loved.

When I first came to CSL EMS I was fresh out of grad school. I thought I was going to run the EMS World. Tried my damndest to import everything I learned in an American classroom to the halls of The EMS House. First thing I really learned about grad school was that most of what I learned was better left back there. I was a class “A” moron. I managed to alienate most of the members of CSL EMS within just a few months and the rest of them by the end of that first awful year. That’s a really bad thing when you’re running a volunteer shop because that leaves just you to cover all the empty shifts. There were a lot of empty shifts my first year as Director. I didn’t see a lot of home in those first three hundred days.

I evolved slowly as a Head Coach—it took me a while before I realized our volunteers were seeking the same elusive organizational ideal as me. We all wanted a place where we were appreciated and respected—where folks knew you by your first name—and we judged each other on the care we delivered and nothing else.

You’re all thinking, “What the heck does this have to do with Special Ed?”

Sadly, it was a reminder to me that I still had a long way to go before I could say I was a really effective Head Coach. I had always told the leaders in our organization to be farmers instead of mechanics. ‘We ought to be carefully nurturing our members with all the requisite basics instead of just fixing problems as they occur.’ And here I was, the Head Farmer, and I had missed an important clue. One of my herd had gone off his feed and I had done nothing more than wait for him to come back to the barn. I hadn’t called him at home. I didn’t drop by his apartment. I didn’t  pursue Special Ed with any real interest. You can’t ask people to become the heart and soul of an organization when the Head Coach doesn’t display the very passion he’s demanding of others.

I learned from this experience. I pledged to Look, Listen, and Feel for the emotive clues left by our members. Look, listen, and feel. Look out for your people. Watch for signs that they’re having problems. See if they’re having a good time. Look. Listen to your medics. Hear what they have to say. Listen. Feel for your support team. Share your compassion with your colleagues. Care for your whole team. Feel. Back to basics, people.

Look, listen, and feel. Words to live by.

Ed Pietroniro had a long successful run as one of our Clinical Team Leaders. I challenged him to be everything his former employer wasn’t: loyal to his team members, dedicated to their success, interested in their education, approving of their performance, appreciative of their service, and respectful of their individuality. Special Ed eventually left The EMS House to become a career Paramedic in Ontario.

Be well. Practice big medicine.

Hal Newman | Ghosts

Norm Rooker’s piece on Ghosts got me thinking about the two EMS ghosts I’ve been carrying with me for a long while and whether or not it might be time to share their stories.

They are both old ghosts of young men who died many years ago long before their time.

One them died anonymously as the police still hadn’t confirmed his identity before he bled out before my eyes. The other was someone I knew by first name and who I talked to on the long ride to the ER where he later surrendered to the massive trauma his body had incurred.

In the course of my long career as a paramedic, I never collected souvenirs. I wasn’t a patch collector. I didn’t hold onto all the t-shirts accumulated over the years, services and stations I called temporary homes.

And yet, I’ve got tangible reminders to remember both of my ghosts.

There’s the stethoscope from the ICU at the long-since-shuttered Reddy Memorial Hospital and there’s the copy of my Bethany College yearbook from 1985.

There wasn’t anything I could have done to prevent the deaths of my ghosts. They were probably doomed from the start of the moment that stretched into a life-but-mainly-death struggle that came in the midst of what were likely happy and exciting times in their respective lives.

There was no reversing the kind of trauma each of their bodies experienced and nothing we could do as paramedics would have changed the ultimate outcome of our encounters with one another.

The kid who died in the ER at the Reddy Memorial Hospital was in his late teens or early 20s. He wasn’t even our patient. It was early in 1980. We had rolled into the Reddy with a minor medical patient and were cleaning up and completing paperwork.

The Reddy was a throwback to another time when hospitals were smaller and ERs had both regular patients and staff. The Reddy was the go-to ER for many of the poorest neighbourhoods in the southwest part of Montreal. We were Reddy Regulars. We got along well with the docs, the nurses, the orderlies and the registration staff. The Reddy handled more ETOH and drug OD patients than many of the other ERs in the city – and they had their sh*t together on an OD. There were some great docs and nurses who called The Reddy home.

That afternoon we were cleaning up in the ER and getting ready to get back on our rig when a car pulled up. The back door opened and the first thing I noticed was all the blood. There was a fine mist of blood sprayed on the seat, the windows, and the ceiling. There was a kid in the backseat and he seemed to be the source for all the blood.

We got him onto a gurney and hauled him into the resusc room. He was as pale as the fresh-from-the-laundry sheets stacked on the shelves. Every time he took an agonizing breath, the blood would spray out of a hole in his chest like some surreal whale coming up for air inside his gut. Turns out he’d taken a steel-jacketed military round to the chest and while his friends were hauling him up the road to the much-better-equipped trauma center at the Montreal General Hospital, they saw our ambulances and made a spur of the fucked-up moment detour to The Reddy Memorial.

We helped them code him. We called for back-up. In a surreal scene, another one of our rigs responded to The Reddy’s ER.

Of course, it didn’t matter what we did. That round had come from an M-16 and had already ripped through his lung and out his back leaving a rather ragged reminder of why it’s so damned important to make weapons safe before posing combat-style with them. The young man bled out while his sucking chest wound played a symphony of wheezing and gurgling sounds until they became lost in the cacaphony of the sideways splish-and-splosh of uniform boots in blood on a linoleum floor, beeping alarms and overhead pages going out on the hospital’s PA system.

He died. He was probably dead when he arrived but his brain had forgot to shut down his heart and lungs so they continued the charade for a while until they, too became exhausted with keeping up appearances and called it a day.

My other ghost was named David although I knew him as Mac.

I was in my Senior year at Bethany College. A friend was visiting me from back home in Montreal. We worked as rescue-medics in Montreal together and Mike had come out to West Virginia to spend a bit of time with me.

We were at a party up at one of the residences when a page came in for a car wreck. I remember asking around for a car so I could get down to the fire station. I think we took my friend Matt’s car. Mike came with me and we rolled down the hill into the hollow that led down into town.

We never made it to the fire station.

It was a scene straight out of hell. A Jeep Cherokee with four or five students aboard had crashed violently. I seem to remember that the vehicle somehow surfed the guardrail for a long distance before rolling over. In the intervening years my brain has done me the favour of erasing many of the details but I believe Mac was ejected from the wreckage headfirst.

I don’t remember what happened to my friend Mike. One moment I was on my way to the fire hall. The next I was up to my elbows in really bad shit and whatever it was would leave a stain on my consciousness forever.

I ended up being part of the EMS crew caring for Mac. I remember talking to him. I don’t remember if he ever replied. It’s a long-ago increasingly foggy nightmarish memory now. I remember telling his fraternity brothers that it didn’t look good in a brutal understatement of the gravity of the situation.

There wasn’t anything we could have done that would have changed the outcome. Once that SUV began to defy the law of gravity it was pretty much a done deal. Mac died forever young. I seem to remember – not really sure but I think so – his parents chose to donate his organs so there may yet be a bit of Mac roaming around out there somewhere.

Those are my EMS ghosts. They are quite courteous and don’t visit me unless I beckon them first, as I did this afternoon. It will be a long while before I call on them again.

Sleep peacefully.

Be well. Practice big medicine.


PS. If you have EMS ghosts of your own and would like to share, drop me a line at

If you need to talk with someone who knows what a burden carrying ghosts can be, please visit the Tema Conter Memorial Trust website. There are excellent resources available and Executive Director Vince Savoia always has time to help an emergency services provider in need of support.

A typical night

Enrico Colantoni and TEMA


Norm Rooker | Ghosts (part 1)

Photo courtesy of Stephane Brunet (c) 2011

Ghosts (part 1) by Norm Rooker

How many of you have read Joe Connelly’s 1998 semi-fictional book ‘Bringing Out The Dead’?  Joe, a former New York City EMS paramedic, spun a very realistic tale of the dark side of EMS.  The parts they don’t tell you about, or at best maybe hint at, in First Responder, EMT & paramedic school.

Made into a movie a few years later, the story is about a burnt out paramedic, played by Nicholas Cage in the film, who is among other things, haunted by his own personal EMS ghost. A former patient, a young female asthma patient, that he was unable to save.  Our exhausted and extremely crispy but still striving to do his best medic keeps spying her out of the corner of his eye in various crowd or street scenes as he responds to calls.

If you haven’t read the book or seen the movie I won’t spoil it for you. But the fact is that most any medic, firefighter, law enforcement officer or ED worker with more than a few months of experience will tell you, if they trust you and are being honest with themselves, that they each have their own “ghosts”.

Those calls or patients that have jarred us or have an emotional impact on us.  The ones you could do nothing for.  The ones if you could have just done this or that differently, a little quicker or maybe just that elusive “something else” that the outcome might have been different.

The one that the VCR/DVR in your head keeps playing over & over again. Or years later will suddenly replay out of the blue triggered by a seemingly innocuous event.

One of the minor disadvantages of a career spanning almost 39 years as an EMT, Paramedic, Firefighter, Rescue Specialist & what not, is that like most of you, I have had more than a ghost or two in my life.

Former patients and/or calls.  Sometimes not even my call but one that happened to someone I knew.  My mind would obsess about how I would have handled that call, that situation.

For instance, back in the late 80’s several friends of mine responded to one of those freak, once in a career, type calls. The call and the patient’s death haunted/danced in & out of my dreams for almost 18 years.  Mainly because at that time I wouldn’t have done anything different than they did. And great medic that I liked to believe I was at that time, I would have come up with the same tragic outcome had this call been mine.

My mind & subconscious chewed on this rescue problem for almost 2 decades until I finally worked out both how to have correctly and realistically identified that patient’s unique predicament and how I would have then run treatment and rescue/extrication with a real chance of success.

The story.  A mother was driving a carload of kids to an after school event.  They were on the highway and heard a loud thump from the bottom of the car & simultaneously the mother felt a burning sensation in the back of her neck at the base and a sudden weakness.

She was able to safely decelerate and pull her car off to the shoulder of the highway.  One of her kids used her cell phone, this was back in the late 80’s when not everyone had one, and called 911.

My friends were on the first responding engine and ambulance.  On their arrival they got the kids out of the car and safely in the care of a police officer.

Their physical assessment revealed a conscious & awake woman c/o of a sudden onset of a dull burning sensation at the base of her neck with full body weakness.  Physical exam was unremarkable except for a lump/deformity with no point tenderness just to the right of her spinal column at the C7/T1 level.  No medical history to speak of, no RX or drug allergies and normal vital signs except for a slightly elevated pulse.

At a loss for the cause of the sudden onset but noting the deformity the woman was placed in c-spine precautions including a c-collar and KED, Kendrick Extrication Device.  Just like many of us would have done.

The problem came when they attempted to extricate her from the driver’s seat out onto the backboard.  This wasn’t any, “Ma’am, can you swing your legs around and have seat on our backboard.” type extrication.  This was the full blown deal.

They went to lift her up to swing her torso around in preparation to laying her flat on the backboard when she let a little moan and died.  One of my friends said the closest way he could describe it was like a cartoon where the color just drained out of her from the top down.

They also discovered they were encountering resistance from her hips, so they lifted her a little higher and discovered there was something sticking out of her.

It was only after they angled her head out of the driver’s door and lifted her almost 3 feet into the air that they discovered the problem.  Rebar.

The California Highway Patrol accident reconstruction team discovered that a 6 foot piece of rebar had fallen off a vehicle and was laying on the highway.  The woman’s car had driven over it at just the wrong angle that the rebar bounced off the pavement and penetrated up through the floor of the car, the driver’s seat and into the driver.

It was one of those freak billion-to-one accidents.  But that didn’t change the shock, horror and frustration for my friends who had a patient that was alive when they got to her and during their actions to “help”, died in their arms.

They ran the code but it was one of those “Humpty Dumpty” type of resuscitations.  The kind where all the King’s horses and all the King’s medics couldn’t put Humpty Dumpty back together again.

This wasn’t even my call.  I never met this woman.  I have no idea what she looked like or even whether she was a good mother and/or wife or not.

But still, I obsessed on the incident.  This could just as easily could have been my call and I am pretty darn sure that I would have taken the exact same actions with the same tragic results.

It took almost 18 years of chewing all aspects of this call over in my mind.  Both conscious and subconscious before I had worked out all the pieces to have maybe, MAYBE, run this call with a different outcome.

I will tell you that the very first thing I did/changed was to start being more consistent in applying that wildland fire safety rule “Look up, look down, look all around” to my patient assessments.

As humans we pretty much look at, view our world and surroundings at eye level.  That looking down for clues/evidence, especially like we see now on TV shows like CSI is a learned or trained behavior, not one that comes naturally to most of us.

The same holds true for looking up.  For overhead obstructions, safety issues like something dangling on a wire or a thread above us.  Everything from a FF waiting in ambush to dump a bucket of water on you as you pass by to IEDs, Improvised Explosive Devices to overhead obstructions prior to swinging an axe or raising a ladder.

Shortly after this accident I incorporated feeling under the patient’s car seat as part of my assessment.  Especially when I had a situation/presentation that wasn’t adding up. While I have never found a patient impaled by rebar, from time to time I have found some clues to my patient’s presentation/predicament at that moment.

That was the easy part. The next challenge was to figure out how to extricate a similarly trapped/impaled patient safely and get them to the hospital alive enough to give the trauma surgeons a viable chance at saving this unfortunate individual.

Being a rescue specialist, I was already teaching structural collapse rescue at the time, I chewed on the extrication side of the problem.  How to stabilize the rebar and cut it between the seat and the floor of the car without jarring or shaking it so badly as to further cause internal injuries to the patient?

How to remove the roof of the car, disconnect the seat from the car and lift the patient and seat as a unit and lay it down on a backboard?  How to secure the seat and patient to the backboard, supporting their legs and the sides so that they had a stable ride to the hospital immobilized in the same position we found them only laying on their, the car seat’s, back? This included how to realistically build up a support for her legs so they didn’t just dangle or flop about.

She was one of my motivations for taking the NFPA, National Fire Protection Association, approved Basic and Advanced Vehicle Extrication courses.

In the meantime, once extricated, how would I go about “packaging” her for transport and what treatments, effective treatments would need to be rendered?  And while all of this sounds good on paper and in my head, I also had to figure out how to communicate the situation to first my fellow medics and FFs on scene so they would accept my proposed plan of action and secondly the receiving hospital so that they would have the appropriate resources ready when we or the air ambulance hit the door.

When I had worked all this out, I was finally able to say goodbye to this woman’s ghost. A second-hand ghost at that as she wasn’t really mine to begin with but rather had become mine via adoption.

This unknown woman was neither the first or final “ghost” of my career.  My first “ghost” came into my life Thanksgiving Eve 1975.  I was 19 and had been an EMT for just over two years.  Most of my experience up to then was either as the medical (cadet) sergeant on a not very active ground search & rescue team or as an EMT for a redneck “mom & pop” private ambulance service that almost exclusively did routine transfers.

Anyway, it was Thanksgiving Eve and I was sharing my first bachelor pad with three good friends I had known since grade school, Boy Scouts and the Civil Air Patrol.  We had all been cadets in the same CAP Squadron that ran a “ranger” team.  It was that CAP affiliation and timing that allowed two of us to have been selected to be part of the second pilot EMT class run in the State of Connecticut over the summer of ‘73 between my junior and senior year of high school.

All four of us have since gone on to careers in emergency service.  Brett and Fred in law enforcement, myself as a paramedic/FF/rescue specialist and Dick as a FF, and ultimately Battalion Chief for the Washington DC Fire & EMS Dept.  Indeed Dick ran part of the roof operations in the battle to save the Pentagon on the night of September 11th.

But that all was in the future. Going back to that Thanksgiving Eve evening, we were just four 18- and 19-year-olds, one in the Army, two going to school full-time and me working full-time as an EMT for Northern Virginia Ambulance Service.

The company, as an early Christmas present, had just issued all of us windbreakers with the company name on the front and back.  Being young and unbelievably proud of what I did, I of course wore that windbreaker on and off duty.

Remember, this was a bachelor pad.  Decorated in second hand and yard sale furniture.  The bunk bed that my brother and I had shared when our ages were both in the lower single digits was disassembled and was now two of the beds for our apartment. The center of decoration for our living room was a combination TV set and high fidelity stereo and an 8-foot wooden bar that one of us had come across at a yard sale and just knew that we had to have.

We weren’t slobs, but we sure weren’t what you would call neat-nicks either.  Brett, who was active duty with the 3rd Division “Old Guard” artillery battery had a waiver to live off-base with us.  For some reason Brett got it into his head after dinner that Wednesday evening, we were going to clean/police the place up for the holiday.

For an even stranger reason, that seemed like a good idea to me as well and the two of us set into it with the gusto and enthusiasm of youth.

A couple hours later we had the place ready to receive our parents should they drop in to visit.  The last task left to do before we called it a night was to take out the trash.

It was a cold November evening so we both donned jackets, me of course in my NVAS windbreaker.  As we carried the trash down to the dumpster we heard a horrific crash.  Our apartment happened to be alongside Interstate 95 by an exit/on ramp.

Photograph courtesy of Stéphane Brunet

We both saw the fireball from the wreck rising up above the tree line along the edge of the highway.  I gave my trash to Brett and ran towards the fence.  By the time I finished clambering over the 8-foot chain link fence and barbed wire fence the first arriving fire engine and ambulance were on scene.

As I came down on my feet and turned to the wreck I saw the fire fighters restraining a man with badly burned arms fighting to get back to the burning vehicle.  I heard two sets of shrieking screams coming from the fully involved vehicle and a child’s small voice calling from the back of an otherwise empty ambulance.

I asked the firefighters if they needed a hand and they directed me to the back of their ambulance.  I climbed in the open back doors to find a young boy, maybe 8 or 9 laying on the gurney with probably 60% second & third degree burns, mostly to the right side of his body.

It was just the two of us back there.  I looked around and grabbed a bottle of sterile water and began pouring it on his burns.  I still remember how the water steamed and rose off of him.  And the smell.  That unique smell of burnt hair and flesh.

I didn’t’ have any trauma shears on me.  I was a young EMS newbie/geek, but even back then I didn’t carry trauma shears on me when I was off duty.

So I found the OB kit, pulled out the scalpel and began cutting this kid’s burnt clothing off him as best I could.  I used the sterile sheet and dressings from the OB kit to cover this young man’s burns and then continued to cool with bottle after bottle of sterile water.

And it was not like this youngster was screaming or writhing in pain.   Just the opposite, he was lying quite still and speaking in a clear, English accented voice inquiring “Please sir, can you tell me how my mother and sister are?”

Blessedly, the way the ambulance was facing and the sounds of the fire engine in pump mode as the firefighters worked to put the car fire out were drowning out the death cries of two of his closest family members and the mourning wails/keening of his badly burnt father who was being treated/restrained in a second ambulance that had arrived on scene after I had initiated taking care of this young man.

I learned later that the father, a counselor officer for an Eastern European country had just brought his family over to the US that very week and he had been showing them the beauty of the Virginia countryside.  He was driving them back to their new living quarters when a drunk driver accelerated up the on-ramp and rear-ended their vehicle causing it to explode.

The father received his burns pulling his son out of the burning vehicle and was trying to go back to attempt to save his wife or daughter when I clambered over the fence and joined in the response.

I rode into the hospital with the FF/paramedic crew, assisting them as they started IVs administered MS, morphine, and all the time trying to find new ways to avoid answering this young boy’s inquires into the status of his mother and sister.

Afterwards the fire crew thanked me and gave me a lift back to my apartment complex.  I worked on the ambulance Thanksgiving Day and then went home on Black Friday to spend the rest of the holidays with my family.

All the time still hearing this young boy’s calmly questioning voice in my head.  Well that and the anguished cries of his dad and the death screams of his mother and sister.

I realized later, much later that this boy was in shock.  That he wasn’t feeling the pain, yet, of his severe injuries that looked and smelled so bad to me.  This young man became one of my driving motivations to become a paramedic so that I could do more than just fake my way through treating him and just pouring water.

I learned this young man succumbed to his injuries a week later. It was because of him that I made it a point to learn all I could about burns, burn injuries and the best way to aggressively, but not overly aggressively treat them. Burn injuries became one of the first subjects I taught/lectured on in various EMT and paramedic training programs.  When I broke out onto the national speaking/lecture circuit, this was also one of the first talks I marketed.

Even now, sharing his story with you over three decades later I still hear his voice in my head.  His spirit doesn’t “haunt” me.  Rather it motivates me.

And continues to do so.  Even though I am in the autumn of my EMS/rescue career I still pursue how to take care of these patients better.  One of the many items on my “bucket” list is to take the ABLS, Advanced Burn Life Support course.

(EMS treatment pearl for those burn patients who are in pain.  If all you have for treatment is Fentanyl or Morphine but medical control is being stingy in allowing you to administer it. You know, following the cardiac/pulmonary edema algorithm for the administration of MS rather than the one for burns/trauma,  “Start with 2-4 mg MS and call back in 10 minutes if you think the patient needs more.”

First of all, don’t wait 10 minutes and when you call back in, stand near your still loudly screaming/shrieking/moaning patient and after making a request for an additional MS order, tell them to hold on a minute while you move out of the vehicle/into another room as you can’t hear their response over the patient’s cries of pain.

Pretty sure that they will become much more liberal in the amount and frequency of MS they will allow you to administer.)

There are of course other “ghosts” in my life/career but I will save sharing some of their tales for the second part of this essay.  I promise to follow up with it in the next month or two.  Until then stay safe, and as my friend Hal first said to me many years ago, always strive to do your best to practice Big Medicine.

Photograph courtesy of Stéphane Brunet


Newman | Stepping up

I’ll just go ahead and tell the story.

“Step up, tell the truth and take responsibility for your actions and all will be big medicine.”

When I said those words I was the newly-minted director of a small Emergency Medical Services department in suburban Montreal attempting to establish an organizational culture wherein the medics had only a few rules to follow:

Respect yourself

Respect your colleagues

Respect your clients

Respect your community

At the time, I had already come to the realization that a loose-leaf binder full of rules wasn’t what The EMS House really needed. We were struggling with lots of little things that were not being done properly – response bags not being refilled, trucks not being plugged-in on cold winter nights, living quarters that weren’t being tidied on a regular basis, etc.

So, I told our crews that no matter what happened, if they stepped up, told the truth and accepted responsibility for their actions we could get on with the art of caring for ourselves and our community in a meaningful way.

Tests come quickly.

Sitting at my desk in the back corner of The EMS House, I looked up distractedly as one of our crews rolled slowly back into station after an emergency run. Instead of the usual sound of boots on steel stairs followed by an exchange of after-action commentary, there was an odd silence.

I took note and stopped what I was doing. Quiet footsteps and the two medics – usually boisterous and outgoing – standing quietly and looking distressed at my door.

“Uh, we had a problem on that last call.”

What kind of problem I asked.

“We attempted to drive right up to the door of the building.”

Okay I said, and..

“We forgot about the low overhang at the entrance.”

Oh, I said, and realized I probably needed to go outside and look at the truck.

Yes, it was a visual. The impact had been pretty intense with the top of the box. Several lights were smashed and there were a couple of serious metalwork reminders of the close encounter with an immoveable object.

“We screwed up. We were so focused on getting to the patient, we forgot we were driving a high-top truck. We’re both prepared to face the consequences.”

Stepped up. Check.

Told the truth. Check.

Accepted responsibility for one’s actions. Check.

Consequences. I assigned each of them to become driver-trainers. No one ever made the same mistake again.

It was a turning point for our little organization and marked the beginning of an incredible gathering of wondrously talented individuals who came together as a cohesive, dedicated and passionate team of care providers.

Be well. Practice big medicine.






Newman | Playlist for The Big One

Stanstead QC | December 13- Big Update to Announce:

The quest to build The Playlist for The Big One now includes an opportunity for artists to submit their tunes to Big Med on Sonicbids.

For those of you who don’t know, Sonicbids helps bands get gigs and promoters book the right bands. The list of folks who are booking great music on Sonicbids is pretty damned impressive – SWSX 2012, Canadian Music Fest, bonnaroo, MTV – and, of course, Big Medicine.

We’re going to feature two or three new artists every week as we build out the Playlist for The Big One. I’m hoping the next Big Med Porch Party will include a few special guest appearances.

You can visit the Big Med Music section to listen to/watch new artists already added to The Playlist for The Big One.  If you’re a musician or know a musician whose work should be considered for The Playlist for The Big One, get hooked-up with Sonicbids and submit your EPK for consideration.

Music often serves as an escape hatch from the high-end stress that is a constant companion for life on the job. Music provides a soundtrack for our memorable calls. Here’s Norm Rooker on working a code in 1986…

“Like running hot to a cardiac arrest call to Jefferson Starship’s “We Built this City”.

It was early 1986 in east San Jose. Cindy Petretto and I were running hot through mid afternoon traffic for a cardiac call, CPR in progress. And what job isn’t made better with a good sound track in the back ground?

We had a classic rock station cranked up, radio KOME (yes, that is a real call sign and they’re still on the air) and while they played a number of rock classics as Cindy threaded us through the just out of school afternoon traffic, the song that was playing as we pulled up on scene was that Starship classic.

Like so many of our cardiac arrests, first responders were already on scene and CPR was in progress. The patient was in a coarse v-fib so we did what we always do, gave her a 200 watt second ride on the lightning and, surprise of surprises, shocked her right into asystole.

Unfortunately a not all that an uncommon but unintended outcome for this V-fib treatment. So now our patient is flat lined and we were attempting to stimulate her heart back up with various chemicals so we could shock it again. Hopefully with a different outcome.

I was on my A game that day and not only got the tube on the first shot but also turned around and sunk an EJ, as the patient had nothing for veins peripherally and Cindy wasn’t having any luck in either arm.

We worked that code to the point of calling it and Cindy was on the telephone with a Base Station Attending getting permission to do so when the patient’s heart said “enough already” and decided to rejoin us. I have never seen this before or since but our patient’s heart spontaneously converted from Aysytole to a perfusing sinus tach. (4 rounds of Epi 1:10,000 and 3 mg of Atropine tends to make the heart beat a little faster, when it chooses to respond.)

“Wait a minute doc! Forget the pronouncement, I need a Dopamine order!”


Cindy and I brought our patient into Valley Medical Center, The Big Valley, where she was admitted to ICU but did not survive her event and passed away for good two days later. We received a nice thank you note from the family not only thanking us for our efforts, but also for giving their family a chance to get together and say their good byes to their mother, grandmother, sister, beloved wife, etc..

It was signed by what we guessed was the entire family. While Cindy and I had succeeded in telling the Grim Reaper “Not Today!” for our patient, and had a fantastic, make that great field save, we were humbly reminded both that it is not a true save unless the patient is able to resume their normal life and that we had not anticipated how many lives our efforts were actually making an impact on.”

I’m still building The Playlist for The Big One.

The Playlist got its start when I invited readers to submit their suggestions for the ultimate soundtrack to listen to while responding to The Big One.

We received a lot of references to mainstream classic artists and tunes however we also were ref’d to some outstanding emerging artists and little known musical gems.

The blog piece continues to morph and has evolved into a complete music section on Big Med.

Now, I’m asking for more of your suggestions and this time around I’d like you to attach specific meaning/context/memories to each piece you submit.

Think of this as the soundtrack for a TV series never made.

The original Playlist for The Big One:

If you’re going to be really prepared for The Big One you’re going to need some great tunes. So, I asked people to send me their suggestions.. the list continues to grow.

Simple Minds–Alive and Kicking

Glenn Frey–The Heat Is On

Men At Work–It’s A Mistake

When In Rome–The Promise

– The previous four tunes were added to The Big One list by Norm Rooker on July 13 2009

Molly Hatchet–Flirting With Disaster

Stevie Ray Vaughn–Couldn’t Stand The Weather

Loudness–Hurricane Eye

The Scorpions–Rock You Like A Hurricane

The Talking Heads–Burning Down The House


Jimmy Buffett–Volcano

Santana–No One To Depend On

The Rolling Stones–Gimme Shelter

Jerry Lee Lewis–Great Balls of Fire

Johnny Cash–Guess Things Happen That Way

Al Green–Let’s Stay Together

The Dells–Oh What A Night

Big Joe Turner–Shake, Rattle, and Roll

The Animals–We Gotta Get Out Of This Place

REO Speedwagon–Ridin’ The Storm Out

Sara Groves–Tornado

Kenny Loggins–Danger Zone

Jimi Hendrix–Fire

Barry McGuire–Eve of Destruction

Tracy Lawrence–Texas Tornado

Fontella Bass–Rescue Me

James Taylor–Fire and Rain

Bruce Springsteen–Across the Border

Bruce Springsteen–Fire

Bruce Springsteen–My City of Ruins

Tragically Hip–New Orleans is Sinking

Led Zeppelin–When the Levee Breaks


Chicago–Does Anybody Know What Time It Is?

Hank Williams, JR–A Country Boy Can Survive

Elvis Presley–All Shook Up

Jimmie Dean–Big John

Bing Crosby–White Christmas

The Crazy World of Arthur Brown–Fire

Katrina & The Waves–Walk on Water

REM–It’s The End Of The World As We Know It [And I Feel Fine]

Gordon Lightfoot–The Wreck of the Edmund Fitzgerald

ACDC–You Shook Me All Night Long

CCR–Have You Seen The Rain

Tears For Fears–Mad World

Moby–The Rain Falls and The Sky Shudders

Live–Lightning Crashes

Beck–Earthquake Weather

The Alarm–Rain in the Summertime

Gnarls Barkley–Run [I’m A Natural Disaster]

Jars of Clay–Flood

The Cure–Shiver and Shake

The Smiths–Panic

Depeche Mode–Shake the Disease

New Order–Confusion

Richard Wagner–Ride of the Valkyries

Billy Joel–

Land of Despair

Only the Good Die Young


We Didn’t Start the Fire

Phil Collins–

Against All Odds

Land Of Confusion

Roof Is Leaking

Electric Light Orchestra–Concerto For A Rainy Day

Standin’ In The Rain

Big Wheels

Summer and Lightning

Mr. Blue Sky

Bad Company–Burning Sky

The Talking Heads–Life During Wartime

CCR–Bad Moon Rising

The Bee Gees–Stayin’ Alive

Bad Company–

Shooting Star

Downpour in Cairo

Lynyrd Skynyrd–Smokestack Lightning

Call Me The Breeze

Dead Man Walking

Gimme Three Steps

Rocking Little Town

Life’s Lessons

Need All My Friends

Alison Krauss–Didn’t Leave Nobody But The Baby

The Whites–Keep On The Sunny Side

The Allman Brothers–Blue Sky

Ritchie Blackmore’s Night–

The Storm

Mid Winter’s Night

Gone With The Wind

Blue Highway–Still Climbing Mountains

Bonnie Raitt–Deep Water

Cate Brothers–There Goes The Neighborhood

Doobie Brothers–Black Water

Lonesome Road–Higher Ground

George Strait–Ready For The End of the World

By The Light Of The Burning Bridge

 The Dixie Chicks–


Top Of The World

 Chris Thile–Brakeman’s Blues

Alison Krauss & Union Station–

Dark Skies

Bright Sunny South

Rain Please Go Away

John Anderson–I Fell In The Water

John Hiatt–

Cold River

Wintertime Blues

The Grascals–

Keep Me From Blowing Away

Rolly Muddy River

Nickle Creek–Why Should The Fire Die

Rhonda Vincent–Drivin’ Nails in My Coffine

Ray Charles–Heat Of The Night

Red Thunder–

Water Night

Heart Beat

Steely Dan–

Rikki Don’t Lose That Number

Everything Must Go

Trace Adkins–If I Fall [You’re Going With Me]

Van Halen–Judgment Day

The Greencards–Weather and Water

Whiskey River Band–Dancing Around The Fire

Enya–A Day Without Rain

Johnny Paychek–Take This Job And Shove It

The Bloodhound Gang–The Roof Is On Fire

Golden Earring–

Twilight Zone

Radar Love

Deep Purple–Smoke On The Water

The playground song ‘Ring Around The Rosie’

Green Day–Warning

Twisted Sister–We’re Not Going To Take it

The Who–

Who Are You

Won’t Get Fooled Again

Santana–Oye Como Va

Peter Gabrial–Red Rain

Seals & Crofts–Summer Breeze

Jonathan Edwards–Sunshine [Go Away Today]

Paper Lace–The Night Chicago Died

Johnny Nash–I Can See Clearly Now

Little Feat–Texas Twister


Between The Wheels

Manhattan Project

Force Ten

High Water

Workin’ Them Angles

Yngwie Malmsteen–Blitzkrieg

Cold Chisel–Cheap Wine and a Three Day Growth

Thin Lizzy–The Boys Are Back In Town

The Foo Fighters–In Your Honor

Edwin Starr-War

Rose & The Arrangement–The Cockroach That Ate Cincinnati

Bobby Russell–The Night The Lights Went Out In Georgia

A. Sevison–Give Me Oil For My Lamp

Kingston Trio–This Little Light Of Mine

Al & Willy Simmons–It’s Raining, It’s Pouring

Queen–Another One Bites The Dust

Peter Seeger–All My Trials

The Beatles–With A Little Help From My Friends

Johnny Cash–Goin’ By The Book

Train–Calling All Angels

Nick Cave & The Bad Seeds–[I’ll Love You] Till The End Of The World

Men Without Hats–Pop Goes The World

The Doors–Riders On The Storm

KT Tunstall–Miniature Disasters

Neil Young–Like A Hurricane

Johnny Cash–

Ring Of Fire

Five Feet High And Rising

Jimi Hendrix–The Wind Cries Mary

Billy Ocean–When The Going Gets Tough

Pat Benetar–Hit Me With Your Best Shot

U2–Sunday, Bloody Sunday

Destiny’s Child–Survivor

Reba McEntire–I’m A Survivor

Gloria Gaynor–I Will Survive

Rihanna–Emergency Room


Ultravox–Reap The Wild Wind

Blue Oyster Cult–Burning For You

The Trammps–Disco Inferno

George Winston–New Orleans Shall Rise Again

Bruce Springsteen–The Rising

Gypsy Pistoleros–Livin La Vida Loca

The Psychedelic Furs–Heartbeat

Aurora & Zon del Barrio–Revolu

The Gitanos–Que Loco Mundo

Michel Rivard–Toute Personnelle Fin Du Monde

Monty Python–Always Look On The Bright Side Of Life

Jen Nelson–For What It’s Worth

Steadman–Wave Goodbye

Parks and Gardens–You Are Dead

Grace Potters & The Nocturnals–Ain’t No Time

Jenn Franklin–What Took You So Long

Alvin Jett & the Phat noiZ Blues Band–Angels Sing The Blues

Karen Kosowski–We’ll Find You

The Crystal Method–Keep Hope Alive [There Is Hope Mix]

Norman Greenbaum–Spirit In The Sky

Tom Petty & The Heartbreakers–Free Fallin’


Love And Rockets–Ball of Confusion

Belinda Carlisle–Heaven Is A Place On Earth

The Fixx–One Thing Leads To Another

Elton John–Saturday Night’s Alright For Fighting

Echo & The Bunnymen–People Are Strange

Van Halen–Runnin With The Devil

Bill Noonan Band–Get Off My Land

Hot House Flowers–Hallelujah

Joshua Lebofsky–The Redemption Song

Richard Seguin–

Chanson Pour Durer Toujours

Ice Comme Ailleurs

La Maison Brule

Les Temps Changent

Ten Toes Up–Trip On Troubles

Patti Smith–Are You Experienced?

The Clash–Should I Stay Or Should I Go

Queen–Keep Yourself Alive

Bon Jovi–Wanted Dead Or Alive

Stephane Wrembel–Water Is Life

Kool & The Gang–Emergency

The Lovin’ Spoonful–Summer In The CityThe Eagles–Hotel California

Earth, Wind & Fire–That’s The Way Of The World

Tom Fenton & Ice Nine–Don’t Go Down To The Fallout Shelter [With Anyone Else But Me]

Tom Lehrer–


So Long, Mom [A Song for WWIII]

We Will All Go Together When We Go


The Brothers Johnson–Get The Funk Out Ma Face

The Foo Fighters–Times Like These

Newman | You can hear it in their voices

You can hear it in their voices.

They are the first of the first responders to reach the scene.

You can hear something in the tone of the first few seconds of their first update transmitted from the scene. No matter how polished and professional they may be just a hint of adrenalin sneaks into that practiced radio voice.

And sometimes the first one to arrive is a raw rookie with lots of heart and booksmarts but precious little time dealing with life-threatening emergencies in real life.

The call was dispatched as a possible car crash. The caller heard something strange in the woods up the road. “It sounded like an impact with a tree. It might be nothing but I’ve got a bad feeling. It’s awfully sloppy out there tonight. Do you think you could send a crew to check it out?”

And so the call comes out as a possible car crash. No word on injuries. No details on what type of vehicle may be involved.

Three fire/rescue crews leave the station en route to the call. One of the firefighters lives just up the road from the reported location and so he heads to the scene on his own in his personal vehicle.

His mates on the firetrucks are still ten minutes out when the first first responder arrives on the scene.

He attempts his first update. “Damn. We’re going to need the Jaws… they’re all….” His voice breaks just as the transmission breaks into intermittent static.

Another prolonged burst of static with no voiceover.

“Firefighter Smith, do you have an update?”

“Uh..this is Firefighter Smith…it’s a passenger van that’s gone off the road, rolled over and hit a big tree. There are five occupants who were completely ejected, three who were partially ejected, and four who are still inside the wreckage. They’re all unconscious. All of them.”

“Firefighter Smith, can you confirm? There are 12 victims at the scene and they are all unconscious?”

“I confirm 12 victims that I can see. I can’t get all the way inside the wreckage without causing further injury to the occupants trapped underneath the van. There might be more victims.”

Raw rookie gone straight to hell.

When the responding Captain calls in with an initial size-up from the scene he declares a Mass Casualty Incident, requests a two-alarm EMS assignment, and finishes up by asking that the COPE Team respond to the scene because he’s got at least one firefighter who’s already in a world of hurt.

You can hear it in their voices.

You should learn more about Critical Incident Stress by visiting the Tema Conter Memorial Trust online at

Be well. Practice big medicine.



Newman | Unrepentant believer in the impossible

Stanstead Gothic: Hal Newman with rake in hand out on the homestead property.

Stanstead QC | Back when I was the newly-minted director of a small EMS service, my boss called me in for my six-month evaluation. He said, “I’ve got good news and bad news.”

I told him to give me the bad news first.
“As a leader you’re a real disaster.”

Damn. What was the good news, I asked.
“It ain’t terminal – yet.”

And with that bit of exceedingly sage advice, I learned that there’s nothing more empowering than allowing someone with a better approach, a better idea, a better way to bring the project home.

I’ve learned how to become a strategic thinker with the ability to achieve tactical wins and the wisdom to know that often you need to get mud on your face in the battle to figure out the right way to get something done.

As a former paramedic/firefighter who was trained in the time of Look, Listen & Feel, I know that’s a darned good way to stay in touch with your team, your clients, your suppliers, your stakeholders and your community.

I love working with small and struggling emergency services and organizations. I still enjoy the company of a solid global network of much smarter folks than me. Thank goodness for that as the challenges facing smaller emergency services are increasingly complex.

I am an unrepentant believer in the impossible – and subsequently have managed to be a part of teams who have pulled off a series of improbable successes.

I delight in being able to convey the heart and soul of EMS – all over the world – via the digital pages of Big Medicine. It’s been more than a decade since Big Med was launched and it still amazes me when I consider all of the amazing connections made via such an unlikely hub.

Big Medicine = the right people coming together at the right time for the right reasons. When all is right with a given situation, it will be Big Medicine.

If I can be of service to you and yours, please don’t hesitate to drop me a line via email

Be well. Practice big medicine.


PS. While some people will tell you that it ain’t over until the fat lady sings, I will tell you that if she appears on my doorstep I’ll invite her in for a cappuccino and we’ll find a way to make it work – together.



I am stubborn. My wife warned me not to try and change that lightbulb on my own. She told me I ought to ask our neighbour from across the street to lend me a hand. I waited for her to go over to one of her friends for tea and muffins and then I decided to give it a go.

“I have fallen and I cannot get up,” I said in slow and determined fashion to the emergency operator who answered the call I placed to 911. I remembered that series of television ads and winced at the realization I had just used the same line to call for help.

“No, I am not having any difficulty breathing. Yes, I hit my head but no, I did not lose consciousness. No, my neck doesn’t hurt. No, no chest pain to speak of. Yes, I do have some terrible pain in my hips. I am 81-years-old. No, I do not take any prescription medications of any kind. No, I am unable to get up on my own. The pain in my hips is quite intense and it gets worse when I try to move.

“Yes, I understand there might be a lengthy delay before the ambulance gets here. I know it’s very cold outside and I understand you must be very busy. I would not have called if I could get up on my own. I fear I have injured my hip otherwise I would not be calling for help.

“Pardon me for asking but I thought we had first responders in our town who might be able to help me before the ambulance crew is available. Oh, I see. They only respond to higher priority calls. Well, I do understand. I will do my best to stay comfortable until the ambulance crew arrives. Yes, I will certainly call you back if anything changes or I feel worse in any way.”

The light of the afternoon faded into the early darkness of a winter evening and the ceramic tile floor quickly lost any of the heat it had retained. I struck up a conversation with the cat but the cat lost interest and walked away. I watched the time on the microwave clock move slowly minute by minute. I fought the urge to pee.

I concentrated on looking at the photographs of our children and grandchildren we had proudly hung on the livingroom wall. I couldn’t remember the phone number at my wife’s friend’s house. I wanted to cry.

I couldn’t believe that I was all alone, had called for help, and no one was on their way yet. I wondered what level of priority my call for help was for that first responder team.

Were they only concerned about life and death? Were they so busy they could not even spare a moment to check on a resident of the community who had confirmed he was in a spot of trouble?

Had they no idea how important it was to provide a physical presence for someone in a time of extraordinary need?

And so, I lay alone on the kitchen floor with a badly bruised hip for more than forty minutes before the ambulance crew and my anxious and bewildered wife arrived simultaneously.

Right. The preceding was just me, Hal Newman, trying to imagine what it would be like to be all alone and waiting for emergency medical assistance after having been classified as a priority Two or Three call on a day chockfull of priority One calls.

Calls of every priority should be responded to and not only by an ambulance crew.

Actually, I believe it would be rather interesting to have a first response team specially trained to respond to calls of a lower priority to determine whether or not those patients actually need to be attended to by the much scarcer ambulance-based paramedics.

There should never be a monopoly on saving lives or helping people in an extraordinarily difficult moment of their lives.

The clock begins ticking when someone calls for help. The primary consideration should be who can get there quickest to render aid – not which response organization has a ‘claim’ to the territory.

It’s not about what uniform the responder is wearing. Every EMS organization should take an enormous leap of faith forward, work with all of the stakeholders and establish a model that ensures everyone in the community gets the EMS they deserve.

Be well. Practice big medicine.